When Doctors Get Cancer…

Doctors know a lot more about statistics related to surviving diseases than your average patient. That’s why the opinion column in yesterday’s New York Times by Dr. Paul Kalanithi on living and dying was so important. We must live for today, even if we think we can’t go on.

Titled “How Long Have I Got Left?” the essay started with the revelations of a CT scan showing lung cancer spreading through his body. It’s very different when you’re reading a scan for a patient, but in this case, it was the doctor’s own scan and his life was on the line. He had crossed the line from doctor to patient.

Dr. Kalanithi is a chief resident in neurological surgery at Stanford University, and he’s only 36 years old. He found that when you become a patient, suddenly survival rate statistics become very important to you.

Here are some of the phrases doctors say to patients, shared in his essay:

Be honest about the prognosis but always leave some room for hope.

Be vague but accurate about time left – days to weeks, weeks to months, months to years, etc.

It’s impossible to know where an individual patient is in a survival curve, hence, how long a person has got left to live.

When he was on the receiving end of those lines, he was frustrated. A few interesting quotes about what he considered while facing his mortality:

For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens: Nothing could be more obvious when your day’s work includes treating head trauma and brain cancer.

But on my first visit with my oncologist, she mentioned my going back to work someday. Wasn’t I a ghost? No. But then how long did I have? Silence….

I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live….

What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.

In the end, he is now eight months from his prognosis. With a specific cancer treatment, his strength has recovered. And he discovered the words of writer Samuel Beckett: “I can’t go on. I’ll go on.”